Determinants of prematurity in urban Indonesia: a meta-analysis

OBJECTIVES

Indonesia is the fifth country with the highest number of preterm births worldwide. More than a third of neonatal deaths in Indonesia were attributed to preterm birth. Residential areas affected the occurrence of preterm birth due to differing socioeconomic and environmental conditions. Many studies have investigated the determinants of prematurity in Indonesia, however, most of them were performed in rural areas. This study is the first meta-analysis describing the determinants of preterm birth in urban Indonesia, which aimed to become the foundation upon implementing the most suitable preventative measure and policy to reduce the rate of preterm birth.

METHODS

We collected all published papers investigating the determinants of preterm birth in urban Indonesia from PubMed MEDLINE and EMBASE, using keywords developed from the following key concepts: "preterm birth", "determinants", "risk factors", "Indonesia" and the risk factors, such as "high-risk pregnancy", "anemia", "pre-eclampsia", and "infections". Exclusion criteria were multicenter studies that did not perform a specific analysis on the Indonesian population or did not separate urban and rural populations in their analysis, and articles not available in English or Indonesian. The Newcastle Ottawa Scale was used to assess the risk of bias. This systematic review was registered in PROSPERO.

RESULTS

Sixteen articles were included in the analysis and classified into five categories: genetic factors, nutrition, smoking, pregnancy characteristics or complications, and disease-related characteristics.

CONCLUSIONS

Our meta-analysis revealed adolescent pregnancy, smoking, eclampsia, bacterial vaginosis, LC-PUFA, placental vitamin D, and several minerals as the significant determinants of preterm birth in urban Indonesia.

Rome IV Clinical Criteria and Management of Functional Constipation: Indonesian Health Care Professionals' Perspective

Purpose

The updated ROME IV criteria for functional constipation (FC) in children were published in 2016. However, information on the use of these criteria is scarce. This study aimed to report the frequency of the use of the ROME IV criteria by Indonesian pediatricians and general practitioners (GPs) in FC management in infants and toddlers.

Methods

An anonymous cross-sectional online survey was conducted between November 2021 and March 2022.

Results

A total of 248 respondents (183 pediatricians and 65 GPs) from 24 Indonesian provinces completed the survey. Most respondents reported an estimated prevalence of FC to be less than 5% both in infants and toddlers. On average, only 64.6% of respondents frequently used the ROME IV criteria. Pediatricians used the ROME IV criteria more often than GPs did (p<0.001). The most frequently used criteria were painful or hard bowel movements (75.0%) and ≤2 defecations/week (71.4%). Lactulose as a laxative was the preferred treatment choice, followed by changing the standard formula to a specific nutritional formula. Most of the respondents carried out parenteral reassurance and education. Normal growth, as a marker of good digestion and absorption function, and normal stool consistency and frequency were the most reported indicators of gut health.

Conclusion

The ROME IV criteria for functional constipation are not extensively used by pediatricians and GPs in Indonesia. Laxatives and specific nutritional formulas were the most used management approaches in infants and toddlers. Medical education, especially for general practitioners, should be updated.

Predicting Factors for Mortality in Patients After the Modified Blalock-Taussig Shunt Procedure in Developing Countries: A Retrospective Study

Background

Blalock-Taussig (BT) is a palliative procedure that preserves blood circulation to the lungs and alleviates cyanosis in patients with congenital heart diseases and reduced pulmonary blood flow. BT shunt remains a routinely performed procedure in developing countries before definitive surgery. However, evidence on predictor factors of mortality after this procedure is still scarce in Indonesia. This study evaluated the predictive factors of mortality after the BT shunt procedure.

Methods

This retrospective study evaluated the medical record data of all postoperative BT shunt patients at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from 2016 to 2020. We performed univariate and multivariate analyses to identify the predictors of in-hospital mortality.

Results

The total subjects in this study were 197 children, 107 (54.3%) boys and 90 (45.7%) girls. The median values for age and body weight at the time of surgery were 20 months (11 days - 32 years) and 7.9 (2.7-42) kg. The most prevalent diagnosis was the Tetralogy of Fallot, found in 80 (40.6%) patients. In-hospital postoperative mortality was 20.8% (41 patients). Based on multivariate analysis, predictors associated with mortality were weight <4.25 kg (OR 20.9; 95% CI 7.4-59.0; p < 0.0001) and emergency procedures (OR 3.5; 95% CI 1.3-9.5; p = 0.016).

Conclusion

The mortality rate after BT shunt at PJT Rumah Sakit Cipto Mangunkusumo was 20.8%. Based on multivariate analysis, weight <4.25 kg and emergency procedures are two predictors of mortality in BT shunt.

Relationship between psychological stress with functional constipation in children: a systematic review

Introduction

constipation affects up to 29.6% of children worldwide, making it one of the most common gastrointestinal illnesses in the pediatric population. As a functional disorder, the development of constipation is mostly influenced by a child´s psychosocial condition, even considered as one of important contributing factors. This systematic review aims to evaluate the relationship between psychological stress with constipation in the pediatric population.

Methods

three online databases were searched as study sources, including PubMed, the Cochrane Library, and Google Scholar. Study selection was carried out using the PRISMA diagram. Studies that met the eligibility criteria were then included in the data extraction and synthesis. The study quality assessment was done using the Joanna Briggs Institute's (JBI) critical appraisal checklist.

Results

eleven studies are included in this systematic review, consisting of four cross sectional studies, four case control studies and three cohort studies. The included studies have good quality based on the assessment. Majority of the studies showed a significant relationship between psychological stress and constipation in children. Psychological stress in children can be classified into family-related stressors, school-related stressors, exposure to stressful life events, stress related to psychological disorders, and other factors.

Conclusion

psychological stress and burden are associated to constipation in children. To overcome functional constipation in children, a collaborative effort is required between parents, children, and the healthcare professional.

Human Milk Oligosaccharide Profiles and the Secretor and Lewis Gene Status of Indonesian Lactating Mothers

Purpose

Human milk oligosaccharides (HMOs) may be genetically determined based on the secretor and Lewis status of the mother. This study aims to determine the HMO profile and the secretor and Lewis gene status of Indonesian lactating mothers.

Methods

Baseline data of 120 mother-infant pairs between 0-4 months post-partum obtained from a prospective longitudinal study was used. The concentrations of 2'-fucosyllactose (2'FL), lacto-N-fucopentaose I (LNFP I), lacto-N-tetraose (LNT), lacto-N-neotetraose (LNnT), 3'-sialyllactose (3'SL), and 6'-sialyllactose (6'SL) were measured. Genetic analysis was performed for mothers using targeted next-generation sequencing and Sanger sequencing. Wild-type AA with the rs1047781 (A385T) polymorphism was categorized as secretor positive, while heterozygous mutant AT was classified as a weak secretor. The presence of rs28362459 (T59G) heterozygous mutant AC and rs3745635 (G508A) heterozygous mutant CT genes indicated a Lewis negative status, and the absence of these genes indicated a positive status. Subsequently, breast milk was classified into various groups, namely Group 1: Secretor+Lewis+ (Se+Le+), Group 2: Secretor-Lewis+ (Se-Le+), Group 3: Secretor+Lewis- (Se+Le-), and Group 4: Secretor-Lewis- (Se-Le-). Data were analyzed using the Mann-Whitney and Kruskal-Wallis rank tests, and a p-value of 0.05 indicated statistical significance.

Results

A total of 58.3% and 41.7% of the samples had positive and weak secretor statuses, respectively. The proportion of those in Group 1 was 85%, while 15% were Group 3. The results showed that only 2'FL significantly differed according to the secretor status (p-value=0.018).

Conclusion

All Indonesian lactating mothers in this study were secretor positive, and most of them had a Lewis-positive status.

Association Between Pediatric Gastroesophageal Reflux Disease Symptom and Quality of Life Questionnaire Score, Endoscopy and Biopsy in Children with Clinical Gastroesophageal Reflux Disease: A Prospective Study

Purpose

Gastro esophageal reflux disease (GERD) is a burdensome disease affecting many children. A clinical examination is reported to be unreliable to diagnose GERD in children. This study aimed to investigate the relationship between the Pediatric Gastroesophageal Reflux Disease Symptom and Quality of Life Questionnaire (PGSQ) and endoscopic and histopathological findings in children with symptoms suggesting GERD. Changes in the PGSQ score in children with esophagitis as response to one month therapy were recorded as secondary outcome.

Methods

This is a prospective cohort study in the pediatric outpatient clinic in an Indonesian tertiary hospital. Children aged 2-17 years old with clinical symptoms suspected of GERD are included in the study. Blinded endoscopic and histopathological examination was performed in all patients before one month proton pump inhibitors (PPI) therapy. The PGSQ information was collected at inclusion and after one month PPI treatment.

Results

Fifty-eight subjects were included. Esophagitis was found in 60.9% of subjects according to endoscopy and 58.6% according to histology. There was no significant relationship between the PGSQ score and endoscopic (p=0.781) nor biopsy (p=0.740) examinations. The PGSQ showed a low diagnostic value compared to endoscopy and biopsy (area under the curve [AUC] 0.477, p=0.477, 95% confidence interval [CI] 0.326-0.629 and AUC 0.474, p=0.740 (95% CI 0.321-0.627 respectively). The PGSQ improved significantly post one month of PPI treatment.

Conclusion

The PGSQ cannot be used to diagnose esophagitis in children with clinical symptoms suggesting GERD. However, the PGSQ can be used to monitor the treatment response in children with esophagitis.

Factors associated with parental intention to vaccinate their preschool children against COVID-19: a cross-sectional survey in urban area of Jakarta, Indonesia

Purpose

We reported a survey-based study assessing the parental intention to vaccinate children of 5 to 7 years old against coronavirus disease 2019 (COVID-19). The aim of this study is to assess factors influencing the parental intention to vaccinate their children against COVID-19.

Materials and Methods

This study adopted a cross-sectional design, held at the public health center of Senen district, Jakarta, Indonesia from November 1-30, 2022. The off-line questionnaires were distributed via the school administrator to all eligible parents. Factors associated with intention to vaccinate were analyzed with the regression logistic models.

Results

Of the 435 parents in this study, 215 had already vaccinated their children against COVID-19 (49.4%), and the overall intention of the participants to vaccinate was 69.7%. Factors associated with intention to vaccinate the children against COVID-19 were parental employment status, parental COVID-19 vaccine status and concern of contracting COVID-19. Parents who are employed, had completed vaccines with COVID-19 booster vaccine, and had concern of their children contracting COVID-19 were more likely to vaccinate their children (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.22-3.69; p=0.011; OR, 2.15; 95% CI, 1.21-3.83; p=0.013; OR, 2.40; 95% CI, 1.34-4.30; p=0.004, respectively). Concern on the vaccine's side effects was negatively associated with the willingness to vaccinate.

Conclusion

This study showed that childhood COVID-19 vaccine only covered half of the population, with parental intentions for childhood COVID-19 vaccination being high, reaching almost two-thirds of the study participants. Factors influencing parental intentions were employment status, parental COVID-19 vaccine status, concerns about COVID-19 and concerns about vaccine side effects.

Indonesian pediatricians’ understanding and management of infant regurgitation based on Rome IV criteria

Background The diagnostic criteria of infant regurgitation have been well elucidated in the Rome IV criteria and pediatricians have been informed of them. However, as a functional disorder, infant regurgitation is susceptible to misdiagnosis and inappropriate management. Objective To assess pediatricians’ diagnostic knowledge of and therapeutic approach to infant regurgitation. Methods We conducted a cross-sectional, analytical study using a questionnaire based on Rome IV criteria for infant regurgitation diagnosis and standardized guidelines for management. The questionnaire was face-level validated by an expert and tested for both reliability and correlation using 30 test respondents. The questionnaire was then distributed electronically to 131 randomized pediatricians, who were members of the Indonesian Pediatric Society DKI Jakarta branch and graduated from pediatric residency within year 2005-2019. Results Sixty-seven (51%) pediatricians reported applying the Rome IV criteria in daily clinical practice. Pediatricians who used Rome IV as their source of knowledge achieved mean and median diagnostic knowledge scores of 14.87 (SD 2.540) and 16 (range 8–20), respectively, with no significant correlation between the usage of ROME IV and the pediatricians’ diagnostic understanding (P=0.110), and mean and median therapeutic knowledge scores of 9.10 (SD 2.264) and 10 (range 4–12), respectively, with no significant correlation between the usage of ROME IV and the pediatricians’ therapeutic approach (P=0.486). Pediatricians’ diagnostic knowledge and therapeutic approach were not significantly different with regards to their practice experience, specialist institution, workplaces, and source of information. Conclusion The majority of pediatricians surveyed have good diagnostic and therapeutic knowledge scores with regards to handling of Rome IV infant regurgitation.

Managing Cow's Milk Protein Allergy in Indonesia: A Cost-effectiveness Analysis of Hypoallergenic Milk Formulas from the Private Payers' Perspective

Background: Cow's milk protein allergy is very common in early childhood. Extensively hydrolyzed formulas are recommended in the first-line management of cow's milk protein allergy in non-breastfed children. Choice of formulas should be informed by efficacy and cost data. Objectives: This study aims to compare the cost-effectiveness of extensively hydrolyzed casein formula with Lacticaseibacillus rhamnosus Gorbach Goldin (EHCF+LGG), extensively hydrolyzed whey formula (EHWF), amino acid formula, and soy formula in the first-line management of cow's milk protein allergy in non-breastfed children in Indonesia. Methods: A trial-based decision analytic cohort model was adapted to simulate the occurrence of cow's milk protein allergy symptoms or being symptom free. The model was based on a prospective nonrandomized study that followed up children for 36 months. Costs and health consequences were discounted at 3% annually. Resources required to manage cow's milk protein allergy and unit costs for clinical appointments and exams were based on a panel of 15 clinicians, from a private payers' perspective. Other unit costs were based on publicly available national data. Results were reported as cost per additional child free from allergic manifestations or per additional immunotolerant child at 3 years, and per life-years under the same conditions. Uncertainty was assessed using deterministic and probabilistic sensitivity analysis. Results: Children receiving EHCF+LGG were associated with more symptom-free time, a higher probability of cow's milk tolerance at 3 years, and lower healthcare resources and transportation use when compared with children receiving other formulas (with 38%-49% lower costs). Formula costs were lower for soy, but EHCF+LGG was predicted to save 9% and 54% of overall costs compared with extensively hydrolyzed whey formula and amino acid formula, respectively. Results were robust to sensitivity analyses. Conclusion: Use of EHCF+LGG resulted in more symptom-free time and the highest 3-year probability of cow's milk tolerance. It also led to healthcare resource and transportation savings when compared with other hypoallergenic milk formulas. Soy formula remained an alternative if formula price represents a major constraint.

Indonesian pediatricians’ knowledge of Rome IV criteria and their therapeutic approach to infantile colic

Background Infantile colic is a functional gastrointestinal disorder (FGID) that occurs in approximately 20% of infants under 6 months. Even though this condition is self-limiting, inappropriate therapy affects the baby’s future quality of life. Therefore, it is essential for physicians, especially pediatricians, to employ a correct diagnosis based on the currently accepted Rome IV criteria and an appropriate therapeutic approach. Objective To assess the gaps in Indonesian pediatricians’ understanding of infantile colic according to Rome IV criteria, their therapeutic approach in managing the condition, and associated factors. Methods We randomly selected 131 pediatricians from the Jakarta Chapter of the Indonesian Pediatric Society to complete a questionnaire aimed at assessing their knowledge on the diagnosis of and therapeutic approach to infantile colic. The questionnaire was scored on a scale of 0 to 20. We evaluated the association between questionnaire scores and their association with several variables, including years of clinical experience, accreditation of pediatric residency institution, type of hospital, and guidelines used. Results Out of the 131 pediatricians selected, 75 (57.3%) had used the Rome IV criteria. The mean knowledge score of those participants was 14.24 (SD 3.32) out of 20. Mean therapeutic approach score of all participants was 11.50 (SD 2.80) out of 16 points. There was no significant association between either knowledge or therapeutic approach score with length of clinical experience, accreditation of pediatric residency institution, hospital type, or guidelines used. Conclusions Most surveyed pediatricians who have used the Rome IV criteria have fairly good knowledge of infantile colic. Overall, pediatricians also have a fairly sound therapeutic approach to infantile colic. However, with mean scores of approximately 70% of the maximum score, education is needed to improve on these areas. Knowledge of and therapeutic approach to infantile colic are not associated with length of clinical experience, accreditation of pediatric residency institution, hospital type, or guidelines used.

Pendekatan Tata Laksana Regurgitasi dan Gastro-esophageal Reflux

Regurgitasi seringkali menyebabkan keadaan tidak nyaman pada bayi dan orangtua. Pendekatan diagnosis dan terapi yang rasional diperlukan agar kualitas hidup bayi dan ibu tetap terjaga. Kriteria diagnosis regurgitasi berdasarkan Kriteria Rome IV. Deteksi alarm sign menjadi bagian pendekatan diagnosis regurgitasi atau gastroesophageal reflux (GER). Alarm signs dapat dibagi menjadi dua kelompok, yaitu (1) kemungkinan GER Diseases (GERD) dan kelainan anatomi atau (2) kemungkinan alergi protein susu sapi. Bayi menangis berkepanjangan, iritabel, dan rewel tidak dapat dipakai sebagai gejala satu-satunya untuk menegakkan diagnosis GERD. Beberapa pendekatan terapi direkomendasikan saat ini, yaitu (1) parental reassurance, (2) teknik pemberian minum, (3) thickening milk, (4) alternatif susu formula, (5) posisi bayi, dan (6) tidak memberikan obat. Pemberian small frequent feeding mungkin akan mengurangi frekuensi regurgitasi, tetapi juga akan meningkatkan frekuensi GER. Proton pump inhibitor (PPI) bukan prokinetik sehingga pemberian pada bayi yang mengalami regurgitasi adalah sikap yang tidak rasional. Bayi dengan regurgitasi disertai menangis berkepanjangan tidak dapat dipakai sebagai dasar untuk memberikan terapi PPI empiris.

Resuscitation of very preterm infants with 30% vs. 50% oxygen: a randomized controlled trial

Background Preterm infants are susceptible to the damaging effects of hyperoxia which may lead to bronchopulmonary dysplasia (BPD) and intestinal damage. Hyperoxia also affects intestinal microbiota. The optimal initial FiO2 for the resuscitation of premature infants is unknown. Objective To determine the effect of different initial oxygen concentrations on BPD, oxidative stress markers, damage to the gastrointestinal mucosa, and the intestinal microbiome. Methods We conducted an unblinded, randomized controlled clinical trial in premature infants requiring supplemental oxygen in the first minutes of life. Infants started at an FiO2 of either 30% (low) or 50% (moderate), which was adjusted to achieve target oxygen saturations (SpO2) of 88-92% by 10 minutes of life using pulse oximetry. The primary outcome was incidence of BPD. Secondary outcomes included markers of oxidative stress [oxidized glutathione (GSH)/reduced glutathione (GSSG) ratio and malondialdehyde (MDA)], intestinal integrity indicated by fecal alpha-1 antitrypsin (AAT), and intestinal microbiota on fecal examination. Results Eighty-four infants were recruited. There was no significant difference in rates of BPD between the 30% FiO2 and 50% FiO2 groups (42.8% vs. 40.5%, respectively). Nor were there significant differences in GSH/GSSG ratios, MDA concentrations, fecal AAT levels, or changes in facultative anaerobic and anaerobic microbiota between groups. Conclusion In premature infants resuscitated using low vs. moderate initial FiO2 levels, we find no significant differences in BPD incidence, markers of oxidative stress, intestinal mucosa integrity, or intestinal microbiota.

How to manage irritable bowel syndrome in children

AIM

This paper discusses the risk factors and management of paediatric irritable bowel syndrome (IBS), with a focus on the role of the gastrointestinal microbiome.

METHODS

English articles of interest published in PubMed and Google Scholar were searched using subject heading and keywords of interest.

RESULTS

Only few randomised controlled trials on the management of IBS in children have been published. The vast majority of these intervention trials target to change the composition of the gastrointestinal microbiome. Most studies are underpowered. Major heterogeneities in study designs such as differences in inclusion criteria, including patients with different pain-related functional gastrointestinal disorders and differences in primary outcomes, make it impossible to formulate recommendations. Overall, few adverse events are reported what could indicate safety or point to suboptimal conduction of clinical trials and safety reporting. However, it can also not be excluded that some interventions such as the administration of selected probiotic products may result in benefit.

CONCLUSION

There is insufficient evidence to recommend any therapeutic intervention in paediatric IBS, including manipulation of the gastrointestinal tract microbiome, despite the evidence that dysbiosis seems an associated pathophysiologic factor. More designed prospective trials are needed since IBS is not a rare condition during childhood.

Human Milk Oligosaccharides as a Missing Piece in Combating Nutritional Issues during Exclusive Breastfeeding

Extensive studies have shown that breast milk is the best source of nutrition for infants, especially during the first six months, because it fulfills almost all of their nutritional needs. Among the many functional building blocks in breast milk, human milk oligosaccharides (HMOs) have been receiving more attention recently. Furthermore, it is the third most common group of compounds in human milk, and studies have demonstrated the health benefits it provides for infants, including improved nutritional status. HMOs were previously known as the 'bifidus factor' due to their 'bifidogenic' or prebiotic effects, which enabled the nourishment of the gastrointestinal microbiota. Healthy gastrointestinal microbiota are intestinal health substrates that increase nutrient absorption and reduce the incidence of diarrhea. In addition, HMOs, directly and indirectly, protect infants against infections and strengthen their immune system, leading to a positive energy balance and promoting normal growth. Non-modifiable factors, such as genetics, and modifiable factors (e.g., maternal health, diet, nutritional status, environment) can influence the HMO profile. This review provides an overview of the current understanding of how HMOs can contribute to the prevention and treatment of nutritional issues during exclusive breastfeeding.

Micronutrient Content and Total Lactic Acid Bacteria of Dadiah Pudding as Food Supplementation for Pregnant Women

BACKGROUND: Dadiah, traditional yogurt from Indonesia, which is known as a source of probiotics, also contains micronutrients. AIM: This descriptive study aimed to determine whether additional ingredients and processes during the manufacture of Dadiah pudding maintain the iron, zinc, calcium, and total lactic acid bacteria (LAB) contents. METHODS: Dadiah pudding was made using Dadiah originated from Bukittinggi, West Sumatra. Micronutrient levels were analyzed according to Indonesian National Standard 01-2896-1998. The total LAB were counted by inoculating samples on Man, Rogosa, and Sharpe agar with serial dilution, and morphological identification was carried out using gram stain. RESULTS: In 100 g of original Dadiah, mango and chocolate Dadiah pudding contained 347.98, 276.61, and 279.29 mg of calcium; 4.87, 3.75, and 6.31 mg of zinc; 6.53, 6.60, and 9.39 mg of iron; and 6.4 × 10⁹, 6.1 × 10⁹, and 2.4 × 10⁹ CFU/ml LAB, respectively. CONCLUSION: This study found that modifying the original Dadiah into Dadiah pudding has been proved to affect the concentration of calcium, zinc, and iron and to maintain total LAB. We suggest that consuming Dadiah pudding may be a good choice as a food supplementation for pregnant women to optimize the golden period outcomes.

The role of soy plant-based formula supplemented with dietary fiber to support children's growth and development: An expert opinion

OBJECTIVES

Soy-based formula has evolved in usage and processing technology since its introduction in 1909, and has been used as substitute formula for infants or children with cow milk allergy since 1929. At present, personal opinions, religious background, availability, palatability, and cost are part of the reasons soy-based formula is chosen. Technology in processing soy-based formula has evolved from using soy flour to soy protein isolate, which provides advantages. However, concerns remain regarding the impact of its use on the growth and development of children.

METHODS

An expert meeting, attended by 12 experts, was initiated in Jakarta, Indonesia, to obtain an evidence-based consensus on the role of soy protein isolate formula, as well as its nutritional value to support growth and development.

RESULTS

Ensuring that plant-based formula (i.e., soy protein isolate formula) is fortified with key nutrients, such as calcium, iron, and dietary fiber is important.

CONCLUSIONS

Consensus was achieved, concluding that soy protein isolate formula is safe, affordable, and an alternative option for cow's milk-based formula for term infants.

Partially Hydrolyzed Whey Protein: A Review of Current Evidence, Implementation, and Further Directions

Background: Human milk is known to be the best nutrition for infants as it provides many health benefits. For non-breastfed infants, cow's milk based infant formula is the most optimal option to provide the needed nutrition. However, approximately 2-5% of all formula-fed infants experience cow’s milk allergy during their first year of life. Partially hydrolyzed whey formula (pHF-W) have been widely recommended to prevent the development of allergic disease in infants. However, according to epidemiological data, approximately half of the infants developing allergy are not part of the at-risk group.Objectives and Methods: This article aims to review the effects of pHF-W in preventing allergy, especially atopic disease, in all non-breastfed infants, as well as the safety aspect of pHF-W if used as routine formula. The role of pHF-W in the management of functional gastro-intestinal (GI) disorders is also reviewed.Results: Several clinical studies showed that pHF-W decrease the number of infants with eczema. The strongest evidence is provided by the 15-year follow up of the German Infant Nutritional Intervention study which showed reduction in the cumulative incidence of eczema and allergic rhinitis in pHF-W (OR 0.75, 95% CI 0.59-0.96 for eczema; OR 0.67, 95% CI 0.47-0.95 for allergic rhinitis) and casein extensively hydrolysed formula  group (OR 0.60, 95% CI 0.46-0.77 for eczema; OR 0.59, 95% CI 0.41-0.84 for allergic rhinitis), compared to CMF as a control, after 15 years of follow-up. pHF-W was also found to be beneficial in the management of functional GI disorders such as regurgitation, constipation and colic.Conclusions: The use of pHF-W in allergic infants has been recommended in various guidelines across the countries, as a primary prevention of allergic disease. One pHF-W has been approved by the US FDA and the European Commission's European Food Safety Authority (EFSA) for its safety and suitability as a routine infant formula for all healthy infants. According to the data obtained in the management of functional GI disorders, pHF-W is better tolerated than formula with intact protein. Further studies assessing the effect of routine use of pHF-W in a larger population of non-breastfed infants should also be conducted, in order to observe any potential harm and to determine the benefit and cost-effectiveness ratio.

A Narrative Review on the Update in the Prevalence of Infantile Colic, Regurgitation, and Constipation in Young Children: Implications of the ROME IV Criteria

Regurgitation, colic, and constipation are frequently reported Functional Gastrointestinal Disorders (FGIDs) in the first few years of life. In 2016, the diagnostic criteria for FGIDs were changed from ROME III to ROME IV. This review assesses the prevalence of the most frequent FGIDs (colic, regurgitation and constipation) among children aged 0-5 years after the introduction of the later criteria. Articles published from January 1, 2016 to May 1, 2021 were retrieved from PubMed and Google Scholar using relevant keywords. A total of 12 articles were further analyzed based on the inclusion and exclusion criteria. This review consists of two studies (17%) from the Middle East, three (25%) from Asia, two (17%) from the USA, three (25%) from Europe, and one (8%) from Africa. Three studies (25%) were based on data obtained from healthcare professionals, while the rest were parent or caregiver reports. About half of the retrieved studies used the ROME IV criteria. Among infants aged 0-6 months, the reported prevalence of colic ranged between 10-15%, whilst that of regurgitation was 33.9%, and constipation was 1.5%. Among infants aged 0-12 months, the reported prevalence of regurgitation and constipation were 3.4-25.9% and 1.3-17.7%, respectively. The reported prevalence of constipation was 1.3-26% among children aged 13-48 months and 13% among children aged 4-18 years. Despite the large variations due to differences in diagnostic criteria, study respondents and age group, the prevalence of infantile colic was higher, while that for infantile regurgitation and constipation were similar using the ROME IV or III criteria.

Bifidobakterium dan Kesehatan Saluran Cerna Anak

Kolonosisasi mikrobiota saluran cerna yang didominasi oleh mikrobiota sehat merupakan aspek penting dalam optimalisasi kesehatan anak. Komposisi mikrobiota saluran cerna selalu berubah pada setiap keadaan karena banyak faktor yang memengaruhinya. Bifidobacteria terdapat dalam Air Susu Ibu dan mendominasi saluran cerna bayi yang mendapat ASI eksklusif, seringkali dikaitkan dengan kesehatan bayi dan anak dikemudian hari. Bifidobacteria dikategorikan dalam dua kelompok, yaitu (1) spesies Bifidobacteria berasal dari manusia (human residential bifidobacteria/HRB) dan (2) spesies Bifidobacteria yang secara alami berkoloni di hewan/ lingkungan (non-HRB). Bifidobacteria breve, B. longum subsp.infantis, dan B. bifidum adalah HRB yang terdapat pada bayi. Kolonisasi usus bayi ASI eksklusif didominasi oleh HRB saat berusia 2 minggu. Suplementasi HRB memberikan efek protektif NEC pada bayi dengan usia gestasi <34 minggu. Resolusi sakit perut bermakna terlihat pada irritable bowel syndrome yang mendapat suplementasi HRB, walaupun demikian belum cukup kuat bukti untuk menyatakan bahwa probiotik lebih efektif dalam mencegah kolik infantil.

Effect of Supplementation of Zinc, Glutamine, Fiber, and Prebiotics in Presumed Healthy Indonesian Children Aged 1-3 Years

PURPOSE

Impaired intestinal mucosal integrity may affect the gastrointestinal function, especially in relation to nutrition, absorption, and barrier function. The purpose of this study was to measure the prevalence of impaired intestinal mucosal integrity in presumed healthy children aged 1-3 years and assess the effects of zinc, glutamine, fiber, and prebiotic supplementation in them.

METHODS

A cross-sectional study was conducted in 200 children aged 1-3 years in Pasar Minggu, South Jakarta, Indonesia. A randomized double-blind parallel group method clinical trial was then performed to assess the effects of zinc, glutamine, fiber, and prebiotic supplementation.

RESULTS

Elevated calprotectin was found in 91/200 subjects (45.5%) at the onset of the study. After 10 months, 144 subjects completed the study: 72 subjects received the trial formula, whereas the other 72 received the standard formula. A transitory decrease in fecal calprotectin (FC) was observed after 6 months in the subgroup with normal FC levels, who were fed the test formula (p=0.012).

CONCLUSION

The prevalence of impaired intestinal mucosal integrity in this group of Indonesian children aged 1-3 years was high. Supplementation with zinc, glutamine, fiber, and prebiotics during 6 months reduced FC only in those who had low levels at baseline but not in those with impaired integrity.

Benefit and Challenge of Soy Plant-based Formula in Infant and Children

The first report of soy being administered to an infant is over 100 years old (1).  Since the 1960s the composition of soy formula has been better adapted to the nutritional needs of infants and since 2000 infant formula based on soy fulfills European Directives and legislation for infant feeding.Soy infant formula contains a soy protein isolate (95% protein), and methionine, carnitine, taurine, iron, calcium phosphor and zinc are added. Heating destroys the anti-protease activity of soy for over 90 %. In 2016, soy infant formula was still 12% of the USA market and 25 % of infants were fed soy infant formula during their first years of life (2).

Lactobacillus reuteri DSM 17938 Improves Feeding Intolerance in Preterm Infants

PURPOSE

Feeding tolerance is extremely important in preterm infants. This study aimed to evaluate whether preterm infants receiving Lactobacillus reuteri DSM 17938 would develop fewer symptoms of feeding intolerance. Secondary outcomes were duration of parenteral nutrition, time to reach full feeding, length of hospital stay, sepsis, necrotizing enterocolitis (NEC), diarrhea, and mortality.

METHODS

This double-blind randomized controlled trial of L. reuteri DSM 17938 versus placebo included 94 neonates with a gestational age of 28-34 weeks and birth weight of 1,000-1,800 g.

RESULTS

Feeding intolerance (vomiting and/or distension) was less common in the probiotic group than in the placebo group (8.5% vs. 25.5%; relative risk, 0.33; 95% confidence interval, 0.12-0.96; p=0.03). No significant intergroup differences were found in proven sepsis, time to reach full feeding, length of hospital stay, or diarrhea. The prevalence of NEC (stages 2 and 3) was 6.4% in the placebo group vs. 0% in the probiotic group (relative risk, 1.07; 95% confidence interval, 0.99-1.15; p=0.24). Mortality rates were 2.1% in the probiotic group and 8.5% in the placebo group, p=0.36).

CONCLUSION

The administration of L. reuteri DSM 17938 to preterm infants was safe and significantly reduced feeding intolerance. No significant differences were found in any other secondary outcomes.

Functional abdominal pain disorders in adolescents in Indonesia and their association with family related stress

Background

Functional abdominal pain disorders (FAPD) have been widely reported as a major group of gastrointestinal disorders across the world. This study describes the prevalence, related factors, symptomatology and its relationship to emotional stress in Indonesian adolescents.

Methods

This is a cross-sectional study. Adolescents aged 10 to 17 years from nine randomly selected state schools from five districts of Jakarta, Indonesia, were invited to participate. A translated and validated Rome-III self-administered-questionnaire was used to collect data on gastrointestinal symptoms. Data on sociodemographic characteristics, intestinal as well as extra-intestinal symptoms, and exposure to stressful life events were also collected using a separate validated questionnaire.

Results

A total of 1813 questionnaires were included in the analysis [males 739 (40.8%) mean age of 13.54 years + 0.89]. Of them, 209 children (11.5%) fulfilled Rome III criteria of FAPD. Functional abdominal pain (FAP) was reported as the most prevalent subtype (5.8%), followed by functional dyspepsia (3.3%), irritable bowel syndrome (2%) and abdominal migraine (0.4%). The prevalence was higher in girls (p < 0.05) and those exposed to family-related stressful life events (p < 0.05). They include divorce or separation of parents (adjusted OR 2.55, 95% CI 1.75–3.7, p = < 0.001), death of a close family member (adjusted OR 2.24, 95% CI 1.39–3.59, P = 0.001), and father’s alcoholism (adjusted OR 1.94, 95% CI 1.22–3.1, P = 0.005).

Conclusions

FAPD are common paediatric entities among Indonesian adolescents with a prevalence of 11.5%. FAPD were noted to be higher in girls and adolescents exposed to family-related stressful life events.

The Gastroesophageal Reflux Disease Questionnaire in Adolescents: What Is the Best Cutoff Score?

BACKGROUND

A self-assessment questionnaire, the GERD-Questionnaire (GERD-Q) was used to determine the prevalence of GERD in adolescents, describe the related factors, and determine the impact on quality of life (QoL).

METHODS

The incidence of GERD was evaluated using the GERD-Q in adolescents aged 12-18 years. The Pediatric Gastroesophageal Reflux Disease Symptom Questionnaire and Quality of Life Questionnaire (PGSQ-A) for adolescents were additionally administered. Some factors considered related to GERD were also evaluated.

RESULTS

The 520 adolescents were included. The prevalence of suspected GERD, according to a GERD-Q cutoff score of ≥7 was 32.9%, and those drinking soda were 1.7 times more likely to have GERD (95% confidence interval, 1.3-2.2; p<0.001). However, soda consumption was not a risk factor for development of GERD symptoms. Applying a cutoff score of ≥8, only 10.9% of the participants had a positive GERD score, but the association with soda consumption persisted. The median PGSQ-A score in subjects suspected of GERD was 8 (range 0-37) on weekends and 1 (range 0-17) during weekdays (p<0.001) compared to those not suspected of GERD, with a median of 2 (range 0-27) during weekends and 0 (range 0-10) during weekdays. Heartburn, regurgitation, and extraesophageal symptoms correlated significantly with QoL (p<0.001).

CONCLUSION

The prevalence of suspected GERD in adolescents was 32.9% or 10.9%, depending on the cutoff score used. There was a statistically significant difference in PGSQ-A scores between the subjects suspected or not of GERD, indicating an impaired QoL.

The Role of Two Human Milk Oligosaccharides, 2'-Fucosyllactose and Lacto-N-Neotetraose, in Infant Nutrition

Human breast milk contains numerous biomolecules. Human milk oligosaccharides (HMOs) are the third most abundant component of breast milk, after lactose and lipids. Amongst the synthetized HMOs, 2'-fucosyllactose (2'-FL) and lacto-N-neotetraose (LNnT) are widely studied and are considered safe for infant nutrition. Several studies have reported the health benefits of HMOs, which include modulation of the intestinal microbiota, anti-adhesive effect against pathogens, modulation of the intestinal epithelial cell response, and development of the immune system. The amount and diversity of HMOs are determined by the genetic background of the mothers (HMO secretors or non-secretors). The non-secretor mothers secrete lower HMOs than secretor mothers. The breastfed infants of secretor mothers gain more health benefit than those of non-secretor mothers. In conclusion, supplementation of infant formula with 2'-FL and LNnT is a promising innovation for infant nutrition.

Gut microbiome pattern in adolescents with functional gastrointestinal disease

BACKGROUND

Functional gastrointestinal disease (FGID) has a worldwide prevalence of 10-45%, and is one of the most common causes of recurrent abdominal pain in children. FGID is characterized with abdominal discomfort and changes in bowel movement. Alteration in gut microbiota is associated with FGID, but data are limited, and there are no data from Indonesia.

METHODS

A case-control study was conducted in 22 FGID children and 28 healthy subjects aged 13-18 years at the junior high school and senior high school in Central Jakarta. FGID was diagnosed using Rome IV criteria. Age, sex, and level of education were recorded. Stool samples were collected and investigated for Bifidobacterium spp. and Enterobacteriaceae.

RESULTS

Most of the FGID subjects were females (17/22), with a median age of 16 years. The median values of Bifidobacterium spp. were 138.95 (range: 0.2-22,735.8) CFU/gram for the FGID subjects and 232.5 (range: 1.9-38,985.6) CFU/gram in healthy subjects, which showed no statistically significant difference (P = .49). The median values of Enterobacteriaceae were 58.9 (range: 2.5-9577.8) CFU/gram in FGID subjects and 85 (range: 12.1-3139.4) CFU/gram in healthy subjects, which showed no statistically significant difference (P = .94). Our findings indicate that the gut microbiome of adolescents with FGIDs is characterized by a huge variability in levels of Bifidobacterium spp. and Enterobacteriaceae.

CONCLUSION

Because of the wide range detected in the number of Bifidobacterium spp. and Enterobacteriaceae in FGID and healthy subjects, no statistically significant difference was observed. More studies in larger groups of selected patients may be needed.

The Brussels Infant and Toddler Stool Scale: A Study on Interobserver Reliability

OBJECTIVES

The Bristol Stool Form Scale (BSFS) is inadequate for non-toilet trained children. The Brussels Infant and Toddler Stool Scale (BITSS) was developed, consisting of 7 photographs of diapers containing stools of infants and toddlers. We aimed to evaluate interobserver reliability of stool consistency assessment among parents, nurses, and medical doctors (MDs) using the BITSS.

METHODS

In this multicenter cross-sectional study (2016-2017), BITSS photographs were rated according to the BSFS. The reliability of the BITSS was evaluated using the overall proportion of perfect agreement and the linearly weighted κ statistic.

RESULTS

A total of 2462 observers participated: 1181 parents (48.0%), 624 nurses (25.3%), and 657 MDs (26.7%). The best-performing BITSS photographs corresponded with BSFS type 7 (87.5%) and type 4 (87.6%), followed by the BITSS photographs representing BSFS type 6 (75.0%), BSFS type 5 (68.0%), BSFS type 1 (64.8%), and BSFS type 3 (64.6%). The weakest performing BITSS photograph corresponded with BSFS type 2 (49.7%). The overall weighted κ-value was 0.72 (95% CI 0.59-0.85; good agreement). Based on these results, photographs were categorized per stool group as hard (BSFS type 1-3), formed (BSFS type 4), loose (BSFS types 5 and 6), or watery (BSFS type 7) stools. According to this new categorization system, correct allocation for each photograph ranged from 83 to 96% (average: 90%). The overall proportion of correct allocations was 72.8%.

CONCLUSIONS

BITSS showed good agreement with BSFS. Using the newly categorized BITSS photographs, the BITSS is reliable for the assessment of stools of non-toilet trained children in clinical practice and research. A multilanguage translated version of the BITSS can be downloaded at https://bitss-stoolscale.com/.

A perspective on partially hydrolyzed protein infant formula in nonexclusively breastfed infants

The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life to provide optimal nutrition in this critical period of life. After this, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond. For nonbreastfed infants, infant formula is an available option to provide the nutrition needed. Infant formula is usually prepared from industrially modified cow’s milk and processed to adjust for the nutritional needs of infants. However, cow’s milk is one of the most common causes of food allergy, affecting 2%–5% of all formula-fed infants during their first year of life. One strategy to prevent cow’s milk allergy in nonbreastfed infants is the use of partially hydrolyzed formula (pHF) in high-risk infants, which are infants born in families with atopic disease. However, based on an epidemiological study, approximately half of the infants who develop allergy are not part of the at-risk group. This is because the non-at-risk group is significantly larger than the at-risk group and the non-at-risk infants have approximately 15% risk of developing allergies. This study aimed to evaluate the effects of partially hydrolyzed whey formula (pHF-W) in nonbreastfed infants and determine whether pHF-W can prevent atopic disease in high-risk infants and can be used as routine starter formula regardless of the allergy risk status.

Dosage-Related Prebiotic Effects of Inulin in Formula-Fed Infants

PURPOSE

The aim of this study was to identify the minimally meaningful dosage of inulin leading to a prebiotic effect in Indonesian infants.

METHODS

In a randomized controlled double-blinded, parallel, 3-arm intervention study, 164 healthy formula-fed infants aged 3 to 5 months first obtained formula-A (without inulin) during a 4-week adaptation period. Subsequently, 142 subjects were subjected to a 4-week feeding period by administering either formula-A (no inulin), formula-B (0.2 g/100 mL inulin) or formula-C (0.4 g/100 mL inulin). The primary outcome parameter was %-bifidobacteria in faecal samples determined using quantitative polymerase chain reaction analyses. Secondary outcome parameters were faecal %-lactobacilli, pH and stool frequency, and consistency. Growth and tolerance/adverse effects were recorded as safety parameters.

RESULTS

Typical %-bifidobacteria and %-lactobacilli at the end of the adaptation period in the study population were 14% and 2%, respectively. For faecal pH, significant differences between formula groups A vs. C and A vs. B were found at the end of the intervention period. Testing for differences in faecal %-bifidobacteria and %-lactobacilli between groups was hampered by non-normal data set distributions; no statistically significant differences were obtained. Comparisons within groups revealed that only in formula group C, all the three relevant parameters exhibited a significant effect with an increase in faecal %-bifidobacteria and %-lactobacilli and a decrease in pH.

CONCLUSION

A consistent prebiotic effect along with a decrease in pH and increase in %-bifidobacteria and %-lactobacilli was found only in the group administered 0.4 g inulin/100 mL.

Probiotik Pada Gangguan Saluran Cerna Fungsional

Probiotik memiliki kemampuan untuk memengaruhi komposisi mikroflora saluran cerna. Ketika dikonsumsi dalam jumlah adekuat, probiotik memiliki efek positif terhadap kesehatan pejamu. Terdapat beberapa penelitian yang menilai efek terapeutik probiotik terhadap berbagai macam penyakit, termasuk gangguan saluran cerna fungsional pada anak. Gangguan saluran cerna fungsional adalah gangguan yang dianggap terkait dengan saluran cerna, namun tidak dapat dijelaskan oleh kelainan struktural maupun biokimia. Penelitian besar menggunakan probiotik pada gangguan saluran cerna fungsional telah banyak dilakukan. Penggunaan probiotik juga dianggap aman dan hampir tidak pernah dilaporkan efek samping pada rawat jalan. Beragam strain, dosis, dan metodelogi penelitian menjadikan kesulitan dalam menerjemahkan dan menyimpulkan secara keseluruhan hasil penelitian yang ada. Walaupun demikian, beberapa penelitian dengan metodelogi yang baik memperlihatkan fakta bahwa peran probiotik terhadap beberapa gangguan saluran cerna fungsional tidak dapat diabaikan.

Breath Hydrogen Test in Lactose Malabsorption

Lactose is the most important source in mammalian milk. In normal children, Lactose is hydrolyzed by lactase, and directly absorbed into bloodstream by an active transport mechanism. The term of lactose malabsorption is reserved to patients in whom impaired intestinal lactose hydrolysis and uptake has been proven by an appropriate test. The severity of lactose malabsorption and the extent of symptoms vary widely and are the results of several factors such as the amount of ingested lactose, gastric emptying time, intestinal transit time, and colonic flora. The diagnosis of lactose malabsorption is based on clinical findings and the results of appropriate tests. The breath hydrogen test has obvious advantages for pediatric population because it is painless, non-invasive, sensitive and specific. In the absence of bacterial colonization in the small intestine, the elevation of the concentration of hydrogen in the expired air implies the arrival of lactose in the colon. The increasing respiratory excretion of hydrogen is indicative of a deficit of lactase in enterocyte brush border. This test can also be used to show the existence of bacterial growth. Dietary fiber, some drugs, preparation for colonoscopy, colonic pH, and diarrhea can influence the result of breath hydrogen test.

Epidemiology of Paediatric constipation in Indonesia and its association with exposure to stressful life events

Background

We aimed to study the epidemiology and risk factors, including exposure to emotional stress, for constipation in Indonesian children and adolescents of 10–17 year age group.

Methods

A cross-sectional survey using a validated, self-administered questionnaire was conducted in randomly selected children and adolescents in nine state junior high schools from five districts of Jakarta. All of them were from urban areas. Constipation was defined as a diagnosis by using the Rome III criteria.

Results

Of 1796 children included in the analysis, 328 (18.3%; 95% CI 016–0.2) had constipation. Females and those residing in North Jakarta showed risks associated with constipation in school-age children and adolescents. Symptoms independently associated with constipation were abdominal pain (64% vs 43.3% of control) and straining (22.9% vs 6.3%). The prevalence of constipation was significantly higher in those with stressful life events such as father’s alcoholism (adjusted OR 1.91, 95% CI 1.27–2.89, P = 0.002), severe illness of a close family member (adjusted OR 1.77, 95% CI 1.12–2.80, P = 0.014), hospitalization of the child for another illness (adjusted OR 1.68, 95% CI 1.22–2.31, P < 0.001), being bullied at school (adjusted OR 1.67, 95% CI 1.01–2.76, P = 0.047) and loss of a parent’s job (adjusted OR 1.39, 95% CI 1.03–1.88, P = 0.034).

Conclusions

Constipation in children and adolescent is a significant health problem, affecting almost 20% of Indonesian school-age children and adolescents. Common school and home related stressful life events appear to have predisposed these children to develop constipation.

An Electronic Questionnaire Survey Evaluating the Perceived Prevalence and Practices of Lactose Intolerance in 1 to 5 Year Old Children in South East Asia

PURPOSE

Lactose intolerance (LI) is perceived to be frequent in Asia and has been reported to have considerable impact on dietary intake, nutritional status and the quality of life. We aimed to gather information from healthcare professionals on the perceived incidence, diagnosis and management of LI in 1 to 5 year old children in Southeast Asia.

METHODS

An anonymous electronic survey was sent randomly among healthcare professionals registered in the database of the pediatric societies in Thailand, Indonesia, and Singapore between June and October 2016.

RESULTS

In total, 259 health care professionals responded of which 45.5% (n=118) were from Thailand, 37.4% (n=97) from Indonesia and 16.9% (n=44) from Singapore. Of the participants who responded (n=248), primary LI prevalence among children 1 to 3 years of age was estimated to be less than 5% by 56.8%. However, about 18.9% (n=47) answered they did not know/unsure. Regarding secondary LI, 61.6% of respondents (n=153) estimated the prevalence to be less than 15%. But again, 10.8% (n=27) answered they did not know or unsure. Rotavirus gastroenteritis was ranked as the top cause for secondary LI. There was considerable heterogeneity in the diagnostic methods used. The majority of respondents (75%) recommended lactose-free milk to manage primary and secondary LI.

CONCLUSION

More education/training of pediatricians on this topic and further epidemiological studies using a more systematic approach are required.

Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants

AIM

Regurgitation, infantile colic and functional constipation are common functional gastrointestinal disorders (FGIDs) during infancy. Our aim was to carry out a concise review of the literature, evaluate the impact of these common FGIDs on infants and their families, and provide an overview of national and international guidelines and peer-reviewed expert recommendations on their management.

METHODS

National and international guidelines and peer-reviewed expert recommendations on the management of regurgitation, infantile colic and functional constipation were examined and summarised.

RESULTS

Regurgitation, infantile colic and functional constipation cause frequent parental concerns, lead to heavy personal and economic costs for families and impose a financial burden on public healthcare systems. Guidelines emphasise that the first-line management of these common FGIDs should focus on parental education, reassurance and nutritional advice. Nutritional advice should stress the benefits of continuing breastfeeding, while special infant formulas may be considered for non-breastfed infants with common FGIDs. Drug treatment is seldom required, with the exception of functional constipation.

CONCLUSION

By providing complete and updated parental education, reassurance and nutritional advice, healthcare professionals can optimise the management of FGIDs and related symptoms and reduce the inappropriate use of medication or dietary interventions.

Pediatricians lack knowledge for the diagnosis and management of functional constipation in children over 6 mo of age

AIM

To assess the knowledge of general pediatricians througout Indonesia about the diagnosis and treatment of childhood constipation.

METHODS

A comprehensive questionnaire was distributed to general pediatricians from several teaching hospitals and government hospitals all over Indonesia.

RESULTS

Data were obtained from 100 pediatricians, with a mean of 78.34 ± 18.00 mo clinical practice, from 20 cities throughout Indonesia. Suspicion of constipation in a child over 6 mo of age arises when the child presents with a decreased frequency of bowel movements (according to 87% of participants) with a mean of one bowel movement per 3.59 ± 1.0 d, hard stools (83%), blood in the stools (36%), fecal incontinence (33%), and/or difficulty in defecating (47%). Only 26 pediatricians prescribe pharmacologic treatment as first therapeutic approach, while the vast majority prefers nonpharmacologic treatment, mostly (according to 68%) The preferred nonpharmacologic treatment are high-fiber diet (96%), increased fluid intake (90%), toilet training (74%), and abdominal massage (49%). Duration of non-pharmacological treatment was limited to 1 to 2 wk. Seventy percent of the pediatricians recommending toilet training could only mention some elements of the technique, and only 15% was able to explain it fully and correctly. Lactulose is the most frequent pharmacologic intervention used (87% of the participants), and rectal treatment with sodium citrate, sodium lauryl sulfo acetate, and sorbitol is the most frequent rectal treatment (85%). Only 51% will prescribe rectal treatment for fecal impaction. The majority of the pediatricians (69%) expect a positive response during the first week with a mean (± SD) of 4.1 (± 2.56) d. Most participants (86%) treat during one month or even less. And the majority (67%) stops treatment when the frequency and/or consistency of the stools have become normal, or if the patient had no longer complaints.

CONCLUSION

These data provide an insight on the diagnosis and management of constipation in childhood in Indonesia. Although general pediatricians are aware of some important aspects of the diagnosis and mangement of constipation, overall knowledge is limited. Efforts should be made to improve the distribution of existing guidelines. These findings highlight and confirm the difficulties in spreading existing information from guidelines to general pediatricians.

Electrogastrography in Delayed Gastric Emptying

Disorders of gastric motility are generally manifested by an abnormal rate of gastric emptying. The emptying process of the stomach is very complex, and knowledge is limited to the observation that gastric emptying rate is a highly variable phenomenon, and that delayed gastric emptying is frequently the case. The advances in the knowledge of the physiology of gastric muscle and enteric nerves, and the recognition of the patterns of organization of smooth muscle contractions gave a new input to the study of gastric motility. The gastric emptying can be monitored in various ways, such as manometry, scintigraphy, or electrogastrography (EGG). Recently, EGG has received more attention. There is correlation between the EGG signal obtained from body surface electrodes and signals obtained directly from electrodes locates in the gastric muscle (serosal records). Some studies showed an association between EGG-findings and gastric motility disorders, and indicate that EGG is a reliable, non-invasive, useful method to detect gastric myoelectric activity.

Jadwal Imunisasi Anak Usia 0 – 18 tahun Rekomendasi Ikatan Dokter Anak Indonesia 2017

Ikatan Dokter Anak Indonesia melalui Satuan Tugas Imunisasi mengeluarkan rekomendasi Imunisasi IDAI tahun 2017 untuk menggantikan jadwal imunisasi sebelumnya. Jadwal imunisasi 2017 ini bertujuan menyeragamkan jadwal imunisasi rekomendasi IDAI dengan jadwal imunisasi Kementerian Kesehatan RI khususnya untuk imunisasi rutin. Jadwal imunisasi 2017 juga dibuat berdasarkan ketersediaan kombinasi vaksin DTP dengan hepatitis B seperti DTPw-HB-Hib, DTPa-HB-Hib-IPV, dan dalam situasi keterbatasan atau kelangkaan vaksin tertentu seperti vaksin DTPa atau DTPw tanpa kombinasi dengan vaksin lainnya. Hal baru yang terdapat pada jadwal 2017 antara lain: vaksin hepatitis B monovalen tidak perlu diberikan pada usia 1 bulan apabila anak akan mendapat vaksin DTP-Hib kombinasi dengan hepatitis B; bayi paling sedikit harus mendapat satu dosis vaksin IPV (inactivated polio vaccine) bersamaan (simultan) dengan OPV-3 saat pemberian DTP-3; vaksin DTPw direkomendasikan untuk diberikan pada usia 2,3 dan 4 bulan. Hal baru yang lain adalah untuk vaksin influenza dapat diberikan vaksin inaktif trivalen atau quadrivalen, vaksin MMR dapat diberikan pada usia 12 bulan apabila anak belum mendapat vaksin campak pada usia 9 bulan. Vaksin HPV apabila diberikan pada remaja usia 10-13 tahun, pemberian cukup 2 dosis dengan interval 6-12 bulan; respons antibodi setara dengan 3 dosis. Vaksin Japanese Encephalitis direkomendasikan untuk diberikan mulai usia 12 bulan pada daerah endemis atau pada turis yang akan bepergian ke daerah endemis. Vaksin dengue direkomendasikan untuk diberikan pada anak usia 9-16 tahun dengan jadwal 0, 6, dan 12 bulan. Dengan pemberian imunisasi sesuai rekomendasi, diharapkan anak-anak Indonesia terlindungi dari penyakit infeksi yang dapat dicegah dengan imunisasi. 

Ulkus Duodenum pada Anak

Ulkus Duodenum merupakan kerusakan lapisan mukosa sampai lapisan otot duodenum yang dihubungkan dengan proses inflamasi kronis. Berbagai faktor diduga sebagai penyebab keadaan ini, salah satu yang menjadi perhatian pada saat ini adalah infeksi Heliobacter pylori (H.pylori). Meskipun jarang ditemukan pada anak, kelainan ini dapat menyebabkan pendarahan dan perforasi saluran cerna. Ulkus duodenum lebih sering merupakan ulkus peptik primer. Manifestasi gejala klinis bervariasi mulai dari rasa mual, muntah, nyeri perut berulang, anemia, gagal tumbuh, hingga hematemasis dan melena. Endoskopi merupakan tindakan diagnostik pilihan pada kasus yang dicurigai kelainan organik,termasuk ulkus duodenum. Terapi yang diberikan berupa pemberian antagonis reseptor H2 atau proton pump inhibitor (PPI). Eradikasi terhadap H.Pylori harus segera dilaksanakan bila ditemukan bakteri tersebut sebagai penyebabnya.

Pola Defekasi pada Anak

Defekasi merupakan salah satu aktivitas manusia yang harus dilalui di dalam kehidupansehari-harinya. Pola defekasi pada anak sangat bervariasi dan sangat bergantung padafungsi organ, susunan saraf, pola makan, serta usia anak. Menilai pola defekasi padaanak berarti menilai frekuensi defekasi, konsistensi dan warna tinjanya. Berdasarkanpenelitian yang telah dilakukan di beberapa negara di Amerika, Eropa, dan Asia-Pasifikdiketahui bahwa terjadi penurunan frekuensi defekasi sesuai dengan bertambahnya usiaanak, sedangkan perubahan konsistensi dan warna tinja sesuai dengan pola makan. Sejauhini belum pernah dilaporkan tentang pola defekasi pada anak Indonesia.

Infeksi Helicobacter Pylori pada Anak

Helicobacter pylori (H. pylori) berkolonisasi di dalam lambung manusia, terutama padaanak. Infeksi H. pylori pada umumnya asimtomatis. Vacuolating cytotoxin A (Vac A) dancytotoxic-associated gene A (CagA) merupakan faktor virulensi yang dihubungkan denganmanifestasi klinis yang berbeda. Kejadian infeksi ini sangat tinggi di negara berkembangyang dihubungkan dengan kondisi sosial ekonomi dan kebersihan lingkungan. Biakanbiopsi jaringan lambung merupakan uji diagnostik baku emas terhadap infeksi H. pylori.Uji urea napas sangat berguna untuk mengevaluasi eradikasi. Tingkat sensitivitas danspesifisitas pada uji serologi rendah pada masa anak-anak, sedangkan terapi eradikasiyang direkomendasi saat ini terdiri dari proton pump inhibitors (PPI) yang dikombinasidengan 2 jenis antibiotik (klaritromisin, amoksisilin atau metronidazol).

Intoleransi Laktosa pada Anak dengan Nyeri Perut Berulang

Sakit perut berulang (SPB) merupakan masalah yang sering ditemukan pada anakterutama dalam hal pendekatan diagnosis dan tatalaksana. Sebagian besar penyebabSPB adalah gangguan fungsional dan hanya sebagian kecil (10%) yang disebabkan olehkelainan organik. Intoleransi laktosa dilaporkan merupakan penyebab SPB terbanyakpada anak berusia di atas 5 tahun. Intoleransi laktosa terjadi akibat ketidakmampuanlaktase menghidrolisis laktosa yang masuk ke dalam usus halus. Manifestasi klinis yangdiperlihatkan sangat bervariasi seperti mual, muntah, sakit perut, kembung, sering flatusdan diare. Berbagai pemeriksaan penunjang dapat digunakan untuk mendiagnosiskeadaan intoleransi laktosa. Uji hidrogen napas merupakan alat diagnostik pilihan saatini, karena bersifat non invasif dan mempunyai nilai sensitifitas dan spesifisitas yangtinggi, serta sangat mudah dan aman dilakukan pada anak. Biopsi usus masih merupakanuji diagnostik baku emas untuk mengukur aktivitas laktase. Prevalens intoleransi laktosadi berbagai tempat di dunia sangat beragam. Ras dan pola hidup dalam mengkonsumsisusu/produk susu dilaporkan berperan pada aktivitas laktase. Di Indonesia, prevalensintoleransi laktosa pada anak pernah dilaporkan dengan memperlihatkan peningkatanprevalens sesuai dengan bertambahnya usia, tetapi prevalens intoleransi laktosa padaanak yang menderita SPB belum pernah dilaporkan.

Pola Tata laksana Diare Akut di Beberapa Rumah Sakit Swasta di Jakarta; apakah sesuai dengan protokol WHO?

Pada umumnya penyakit diare akut bersifat self limiting disease sehingga seringkalipasien tidak memerlukan pengobatan spesifik. Tata laksana diare akut dengan berbagaiderajat dehidrasi telah dibakukan oleh WHO.Tujuan: Penelitian ini bertujuan untuk menilai pola tata laksana diare akut di luarrumah sakit institusi pendidikan.Metoda: Penelitian deskriptif yang dilakukan secara retrospektif di tiga rumah sakitswasta Jakarta sejak 1 Januari sampai 31 Maret 1999 pada 67 pasien diare akut yangdirawat, berumur 0-24 bulan.Hasil: Didapatkan 37 (55%) anak lelaki dan 30 (45%) anak perempuan menderitadiare akut, terdiri dari tanpa dehidrasi 6 (9%) anak, dehidrasi ringan-sedang 52 (78%)anak, dan dehidrasi berat 9 (13%) anak. Proporsi rentang usia 0-6 bulan sebanyak 23(34%) anak, >6-12 bulan 28 (42%), dan >12-24 bulan 16 (24%). Jumlah pasien diareakut tanpa dan dengan dehidrasi ringan-sedang yang mendapat rehidrasi secara parenteralsebanyak 51 (88%) anak dari 58 anak. Sedangkan sisanya menderita dehidrasi beratdiberi cairan rehidrasi parenteral yang dibagi dalam 24 jam. Pada keseluruhan pasienrawat hanya 37 (55%) anak yang mendapat cairan rehidrasi oral (oralit/Pedialyte).Penggunaan antibiotik didapatkan pada 55 (82%) anak dan anti diare pada 32 (48%)anak. Pemberian ASI hanya didapatkan pada 41 (61%) anak, dan di antaranya pemberianASI dilanjutkan pada 36 (88%) anak, serta dihentikan pada 5 (12%) anak; sedangkan26 (39%) anak sudah tidak mendapatkan ASI. Dari 51 anak yang menggunakan susuformula, didapatkan pemberian susu formula khusus pada 47 (70%) anak danpengenceran susu formula pada 2 (3%) anak. Lama rawat rerata 3 hari, dengan kisaran2 sampai 6 hari, dan 1 anak dirawat lebih dari 7 hari.Kesimpulan: tata laksana diare akut di tiga rumah sakit swasta di Jakarta kurang sesuaidengan panduan/protabel WHO, tampak dari hasil pemakaian CRO hanya pada 50%pasien, antibiotik masih banyak dipakai (90%), dan pemakaian susu formula khususpada 70% anak. Sedangkan pemberian ASI diteruskan cukup baik, yaitu 88%.

Esofagitis Refluks Pada Anak

Esofagitis refluks adalah proses inflamasi pada esofagus akibat refluks gastroesofagus.Toksisitas isi refluks, frekuensi, durasi episode refluks, dan resistensi esofagus terhadapisi refluks merupakan faktor yang berperan terhadap kejadian esofagitis. Gejala klinisesofagitis refluks tidak spesifik. Pada bayi sering terlihat muntah disertai gejala klinisiritabel, tidur tidak nyaman, menolak makan, dan gagal tumbuh, sedangkan pada anakyang lebih besar didapatkan keluhan heartburn dan nyeri epigastrium. Esofagitis tersebarsecara ‘patchy’ dan tidak merata sehingga ketelitian pemeriksaan sangat diperlukan.Secara makroskopis mukosa esofagus dapat terlihat hiperemis, erosi, atau ulkus, sedangkanpada patologi anatomi terlihat gambaran hiperplasia membran basal dengan papila yangmemanjang. Antagonis reseptor H2 dan inhibitor pompa proton (IPP) telah digunakansecara luas untuk terapi esofagitis. Efek jangka pendek, jangka panjang, dan pencegahanrelaps obat-obat tersebut memperlihatkan hasil yang memuaskan, walaupun beberapadata menunjukkan keunggulan IPP dibanding antagonis reseptor H2.

Gambaran Kadar Natrium dan Kalium Plasma Berdasarkan Status Nutrisi Sebelum dan Sesudah Rehidrasi pada Kasus Diare yang Dirawat Di Departemen IKA RSCM

Latar belakang. Pemberian cairan rehidrasi parenteral dapat mengatasi gangguan natrium (Na) dan kalium(K) plasma pada anak dengan diare. Status nutrisi dapat mempengaruhi perbaikan gangguan Na dan Kplasma saat rehidrasi. Respon perbaikan kadar Na dan K plasma pada anak diare dengan status nutrisikurang dan buruk (NKB) berbeda dengan anak status nutrisi baik (NB)Tujuan Menilai pengaruh status nutrisi terhadap kadar Na, K plasma, dan perubahannya pada saat dehidrasidan rehidrasi.Metode. Penelitian potong lintang retrospektif terhadap data sekunder pasien diare yang dirawat diDepartemen IKA RSCM dengan rehidrasi mengunakan cairan KAEN 3B. Kelompok penelitian dibagi menjadikelompok nutrisi baik (NB) dan kelompok nutrisi kurang dan buruk (NKB). Jumlah subjek penelitian 32pada setiap kelompok. Faktor perancu yaitu muntah, demam, terapi oralit, dan gambaran klinis diare.Hasil. Status nutrisi BB/TB kelompok NB 105,1±10,7 dan kelompok NKB 78,2±12,0, dengan nutrisi buruknya28,1%. Pada kelompok NB, kadar Na dehidrasi 135,4±8,17 meq/l, rehidrasi 138,6±6,73 meq/l, meningkat3,2±8,70 meq/l. Pada kelompok NKB, kadar Na dehidrasi 134,3±7,12 meq/l, rehidrasi 132,2±5,23 meq/l,menurun 1,8±6,14 meq/l. Pada kelompok NB, kadar K dehidrasi 3,6±0,86 meq/l, rehidrasi 3,9±0,81 meq/l,meningkat 0,36±0,90 meq/l. Pada kelompok NKB, kadar K dehidrasi 3,7± 0,82 meq/l, rehidrasi 3,9±0,70meq/l, meningkat 0,26±0,70 meq/l. Kesemuanya tidak berbeda bermakna (p>0,05) antara gizi baik atau kurang/buruk. Dari semua variabel perancu muntah (p=0,009) dan komplikasi (p=0,026) yang tersebar tidak merata.Kesimpulan. Tidak didapatkan perbedaan kadar Na dan K saat dehidrasi, rehidrasi, dan perubahannyapada kelompok NB dan NKB 

Diare Persisten: Karakteristik Pasien, Klinis, Laboratorium, dan Penyakit Penyerta

Latar belakang. Diare persisten menjadi perhatian setelah WHO berhasil menurunkan kejadian diare akut dengan upaya rehidrasi oral. Sepuluh persen diare akut karena infeksi berlanjut menjadi diare persisten dengan angka kematian pada balita 35%.Tujuan. Mengetahui karakteristik pasien, manifestasi klinis, laboratorium, dan penyakit penyerta diare persistenMetode. Studi prospektif terhadap anak dengan diare persisten yang berobat di rumah sakit Dr. Cipto Mangunkusumo, Jakarta, sejak 1 Juni sampai 31 Agustus 2005. Data diperoleh dengan mengisi formulir kuesioner yang ditanyakan kepada ibu pasien dan catatan medis pasien saat pertama datang.Hasil. Didapatkan 41 anak menderita diare persisten, usia terbanyak di bawah 5 tahun. Pendidikan ibu terbanyak sekolah menengah atas (48,7%) dengan tingkat ekonomi rendah (80,5%). Sebagian besar anak telah mendapat antibiotik sebelumnya (48,2%). Demam ditemukan pada 63,4% anak, mual dan muntah 48,8%, dan tinja berlendir 53,7%. Penyakit penyerta, gizi buruk 36,6% anak, alergi susu sapi 31,7%, infeksi saluran kencing 24,4%, dan infeksi HIV 19,5%. Anemia dan hipoalbuminemia ditemukan beturut-turut pada 71,4% dan 64,7% anak.Kesimpulan. Diare persisten terutama mengenai balita dengan tingkat ekonomi keluarga dan pendidikan ibu rendah. Demam dan tinja berlendir merupakan manifestasi klinis yang paling sering dijumpai, sedangkan gizi buruk, alergi susu sapi, infeksi saluran kemih dan infeksi HIV merupakan penyakit yang paling sering menyertai diare persisten. Anemia dan hipoalbumineia merupakan kelainan laboratorium yang paling sering ditemukan.

Pengaruh Penambahan Bifidobacterium dalam Susu terhadap Perkembangan Mikroflora Saluran Cerna Anak Usia 12-24 Bulan

Latar belakang. Bifidobacterium telah diketahui sebagai mikroflora saluran cerna yang dominan padabayi dan mempunyai efek positif bagi kesehatan. Namun, dengan bertambahnya usia jumlah mikrofloratersebut menurun dan digantikan oleh bakteri lain termasuk bakteri patogen.Tujuan Penelitian. Mengetahui pengaruh pemberian susu yang mengandung Bifidobacterium terhadapperkembangan mikroflora saluran cerna dan respon imun pada anak usia 12-24 bulan.Metode. Randomized double blind controlled trial, pengamatan dilakukan selama 4 minggu dengan datayang dikumpulkan meliputi antropometri, jumlah Bifidobacterium dalam tinja, dan titer antibodi.Hasil. Bifidobacterium dalam susu formula dapat meningkatkan jumlah Bifidobacterium dan Lactobacillusdalam saluran cerna anak dan menurunkan jumlah bakteri Coliform. Konsumsi susu formula yangmengandung Bifidobacterium juga dapat meningkatkan sistem imun humoral. PenambahanBifidobacterium ke dalam susu formula tidak mempengaruhi aseptabilitas anak.Kesimpulan. Penambahan Bifidobacterium longum BB536, B. breve M16V, dan B. infantis M63 padasusu formula untuk anak usia di atas 1 tahun dapat meningkatkan mikroflora saluran cerna Bifidobacteriadan Lactobacillus serta menekan pertumbuhan bakteri merugikan, Coliform. Pemberian Bifidobacteriadalam susu formula meningkatkan beberapa komponen sistem imun

Faktor Risiko Diare Persisten pada Pasien yang Dirawat di Departemen Ilmu Kesehatan Anak RS Dr. Cipto Mangunkusumo Jakarta

Latar belakang. Program pengobatan rehidrasi oral telah berhasil mengontrol kematian akibat diare akut.Sekitar 3%-20% kasus diare akut pada anak akan berkembang menjadi diare persisten. Kematian akibatdiare persisten cukup tinggi ± 65% dari seluruh kematian akibat diare.Tujuan. Menentukan faktor risiko terjadinya diare persisten dan mengukur besar pengaruh tiap faktorrisiko tersebut terhadap terjadinya diare persisten pada anak yang dirawat di ruang rawat inap bagian anakRS Dr. Cipto Mangukusumo Jakarta.Metode. Rancang penelitian retrospektif, kasus-kontrol. Data penelitian diperoleh dari catatan medikpasien, semua pasien (54 pasien) diare persisten yang dirawat mulai 1 Januari 2004-30 Juni 2007 yangmemenuhi kriteria inklusi dipilih sebagai kasus dan 108 pasien diare akut dipilih secara consecutive samplingsebagai kontrol.Hasil. Pada analisis univariat didapatkan perbedaan bermakna antara 54 pasien dengan diare persisten(kasus) dan 108 pasien dengan diare akut (kontrol) dalam hubungan melanjutnya diare akut menjadi diarepersisten pada faktor risiko: pemberian antibiotik (p=0,042, RO :1,984, IK : 0,021-3,854), anemia (p=0,005,RO :2,568, IK : 1,313-5,024 ) dan malnutrisi (p= 0,001, RO : 10,974, IK :3,442-34,814). Pada regresilogistik multivariat, dua faktor risiko memperlihatkan hubungan yang bermakna yaitu anemia (p=0,025,RO :2,374, IK : 1,117-5,047) dan malnutrisi (p= 0,001, RO : 12,621, IK :3,580-44,814).Kesimpulan. Anemia dan malnutrisi pada diare akut merupakan faktor risiko untuk melanjutnya diare akutmenjadi diare persisten. 

Derajat Kerusakan Mukosa Esofagus pada Anak dengan Penyakit Refluks Gastroesofagus

Latar belakang. Refluks gastroesofagus (RGE) yang berlangsung lama, baik durasi maupun frekuensi dapat menyebabkan berbagai derajat kerusakan mukosa esofagus atau esofagitis. Esofagitis atau penyakit refluks gastroesofagus (PRGE) yang tidak segera ditangani dapat mempengaruhi kualitas hidup anak. Oleh karena itu pembuktian kerusakan mukosa esofagus pada setiap anak yang secara klinis dicurigai mengalami esofagitis menjadi amat penting. Tujuan. Menilai derajat kerusakan mukosa esofagus atau esofagitis pada anak yang secara klinis memperlihatkan gejala PRGE.Metode. Penelitian deskriptif yang dilakukan secara retrospektif terhadap data hasil pemeriksaan endoskopi dari pasien dengan gejala klinis PRGE, dilakukan pada 1 Januari sampai 31 Desember 2009, di Divisi Gastrohepatologi Departemen Ilmu Kesehatan Anak FKUI/RSCM. Derajat kerusakan mukosa esofagus ditentukan berdasarkan kriteria Los Angeles.Hasil. Di antara 58 pasien dengan gejala klinis PRGE yang dilakukan endoskopi, didapatkan 51 pasien (87,9%) mengalami kerusakan mukosa esofagus (esofagitis), yang mencakup 21,6% esofagitis derajat A, 33,3% esofagitis derajat B, 25,5% esofagitis derajat C, dan 19,8% esofagitis derajat D. Tujuh pasien (12,1%) tidak ditemukan kerusakan mukosa esofagus. Gejala klinis terbanyak adalah mual dan muntah pada 25pasien (43,1%), diikuti nyeri perut berulang daerah ulu hati dan regurgitasi, masing-masing pada 20 pasien (34,5%). Kesimpulan.Kerusakan mukosa esofagus akibat refluks gastroesofagus pada anak merupakan keadaan yang perlu diwaspadai pada setiap anak dengan gejala klinis regurgitasi dengan volume dan frekuensi berlebihan, serta gejala klinis PRGE.

Peran Eritromisin terhadap Toleransi Minum Bayi Prematur

Latar belakang. Eritromisin merupakan salah satu obat prokinetik untuk mengatasi intoleransi minum pada bayi prematur karena imaturitas sistem pencernaan. Beberapa penelitian mengenai efektifitas eritromisin dalam mengatasi intoleransi minum akibat imaturitas saluran cerna masih merupakan kontroversi.Tujuan. Mengetahui peran eritromisin dalam meningkatkan toleransi minum bayi prematur.Metode. Penelitian uji kinis prospektif acak terkontrol tersamar ganda pada bulan September 2011-Februari 2012 dengan subyek bayi prematur usia gestasi (UG) 28-36 minggu. Diagnosis intoleransi minum ditetapkan bila residu lambung lambung ≥25% jumlah pemberian minum 6 jam sebelumnya Hasil. Terdapat 36 subyek bayi prematur dengan intoleransi minum yang dibagi menjadi 2 kelompok yaitu 19 subyek mendapat eritromisin (3 mg/kgbb/dosis, 4x sehari selama 7 hari) dan 17 subyek mendapat plasebo berupa larutan sukrosa. Tidak terdapat perbedaan bermakna jumlah episode terjadinya residu pada kedua kelompok (p=0,271), demikian juga dengan analisis subgrup pada UG ≤32 minggu dan >32 minggu (p=0,25) dan (p=0,39). Median lama hari mencapai nutrisi enteral penuh antara kedua kelompok tidak terbukti bermakna secara statistik (p=0,82). Hasil yang tidak bermakna juga didapatkan pada UG ≤32 minggu dan >32 minggu (p=0,61) dan (p=0,60.)Kesimpulan. Pada penelitian ini pemberian eritromisin dosis rendah (3 mg/kgbb/dosis, setiap 6 jam) per oral selama 7 hari tidak terbukti dapat mengurangi residu lambung maupun mempercepat pencapaian nutrisi enteral penuh pada bayi prematur dengan UG 28-36 minggu yang mengalami intoleransi minum.